Ong J J, Hsu P C, Lin L, Yu A, Kass R M, Peter C T, Swerdlow C D
Division of Cardiology and Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Am J Cardiol. 1995 Jan 15;75(2):137-40. doi: 10.1016/s0002-9149(00)80062-4.
Surgery for implantable cardioverter-defibrillators can cause postoperative exacerbation of ventricular and atrial arrhythmias. It is not known whether the techniques of electrode implantation (epicardial vs transvenous) influence the incidence of arrhythmia exacerbation. We reviewed the postoperative course of 229 consecutive patients who received either epicardial (n = 119) or transvenous (n = 110) implantations from 1984 to 1994. Exacerbation of ventricular tachycardia (VT) was defined as an increase in the number of sustained VTs during the postoperative versus the preoperative 2 weeks. Of the entire cohort, 18 patients (8%) developed exacerbation of VT after operation, which was more frequent in patients with epicardial than with transvenous implantations (12% vs 4%, p < 0.03, odds ratio 3.5, 95% confidence interval 1.0 to 13.2). New-onset atrial fibrillation occurred in 15% of patients with epicardial versus 1% of those with transvenous implantations (p = 0.00005, odds ratio 19.4, 95% confidence interval 2.7 to 86.7). These differences persisted after excluding patients with concurrent cardiac surgery. Preoperative occurrence of arrhythmias was the strongest independent predictor for postoperative occurrence (p < 0.01 for VT, p < 0.0001 for atrial fibrillation). Epicardial implantation (p = 0.03) and a history of myocardial infarction (p = 0.04) were independent predictors for postoperative VT exacerbation, whereas epicardial implantation (p < 0.05) and concurrent coronary bypass surgery (p = 0.0001) were independent predictors for postoperative new atrial fibrillation. Perioperative discontinuation of antiarrhythmic drugs did not influence postoperative VT exacerbation. Epicardial implantation was associated with longer length of hospital stay than transvenous implantation (p = 0.0005), independent of age, left ventricular ejection fraction, and concurrent cardiac surgery.
植入式心脏复律除颤器手术可导致术后室性和房性心律失常加重。目前尚不清楚电极植入技术（心外膜植入与经静脉植入）是否会影响心律失常加重的发生率。我们回顾了1984年至1994年间连续接受心外膜植入（n = 119）或经静脉植入（n = 110）的229例患者的术后病程。室性心动过速（VT）加重定义为术后2周与术前2周相比持续VT发作次数增加。在整个队列中，18例患者（8%）术后发生VT加重，心外膜植入患者比经静脉植入患者更常见（12%对4%，p < 0.03，优势比3.5，95%置信区间1.0至13.2）。新发房颤在心外膜植入患者中发生率为15%，而经静脉植入患者中为1%（p = 0.00005，优势比19.4，95%置信区间2.7至86.7）。排除同期进行心脏手术的患者后，这些差异仍然存在。术前心律失常的发生是术后发生的最强独立预测因素（VT为p < 0.01，房颤为p < 0.0001）。心外膜植入（p = 0.03）和心肌梗死病史（p = 0.04）是术后VT加重的独立预测因素，而心外膜植入（p < 0.05）和同期冠状动脉搭桥手术（p = 0.0001）是术后新发房颤的独立预测因素。围手术期停用抗心律失常药物不影响术后VT加重。心外膜植入与住院时间长于经静脉植入相关（p = 0.0005），与年龄、左心室射血分数和同期心脏手术无关。
